Complete or removable partial denture fabricated for placement at the same appointment as extraction of natural teeth

Occlusion May be Mutilated
Makes Jaw Relations Difficult

OVD, Midline & Incisal Edges May Require Change

After Extractions, Prior to Placement

Final Result

• Conventional immediate denture
• intended to be relined to serve long-term
• Interim immediate denture (IID) (transitional):
• after healing a second new complete denture is fabricated as a long-term prosthesis
(Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition . Elsevier, 2003. 9.1)

• Maintenance of
• Appearance
• Circumoral support
• Muscle tone
• Occlusal vertical dimension
• Jaw relationships
• Facial height
• Tongue will not spread out as result of tooth loss
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition . Elsevier, 2003. 9.2.1

• Less postoperative pain & bleeding
• extraction sites protected
• Pressure from denture base
• Easier to duplicate natural tooth shape & position (if desired)
• Easier Adaptation
• Speech, mastication rarely compromised
• Nutrition can be maintained
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition . Elsevier, 2003. 9.2.1

• More challenging to set teeth
– Less space for teeth as ridge resorption hasn’t occurred
• Alveolar ridge undercuts around remaining teeth may make impressions more difficult
• Unstable or inadequate occlusion can make recording centric position difficult
Unstable Occlusion

Explanation to Patients
• Fit is usually not as good as traditional dentures (estimate ridge form)
• Extractions and sore spots from immediate denture can result in more discomfort after initial insertion
Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition . Elsevier, 2013. 9.4.3.1

Explanation to Patients
• Takes time to adapt to chewing and speaking
• Appearance may be unpredictable if anterior try-in not possible
(Zarb, G. Prosthodontic Treatment for Edentulous Patients, 12th Edition . Elsevier, 2013. 9.4.3.1)
No Anterior Try-in

Explanation to Patients
• Should be worn for first 24 hours without removal
• If removed, reinsertion can be difficult if significant swelling occurs
• Patient should return to dental office for initial removal at 24-hours

Explanation to Patients
• Immediate dentures will normally “ loosen ” during healing due to ridge resorption & soft tissue remodeling
• Relines/tissue conditioners will be required to improve the retention
• Normally a permanent reline will be required 4-6 months after insertion

Explanation to Patients
• In some cases a remake may be required
• Significant change in jaw position
• Significant esthetic problem
• May be cheaper/better to remake
• In practice, the patient is normally responsible for fees for relines
• Explain prior to beginning

Dalhousie Faculty of Dentistry Policy
• Immediate denture fee at Dalhousie includes
• tissue conditioners
• one permanent reline within first year of receiving immediate denture(s)
• No additional fees for relines

• Online on Removable Prosthodontics Website
• http://removpros.dentistry.dal.ca/RemovSite/Imm ed_Dentures.html

• No opposing occlusal contacts
• Severely collapsed occlusal vertical dimension
• Can’t register a repeatable jaw relationship
(check at treatment planning appointment)
• Vestibule too short - vestibuloplasty would be required
• Refer

• Sugery & Insertions Thursday afternoons only
• Book at least 2 weeks prior to surgery
• Book with Patient Services Staff
• Identify as a Immediate Dent at time of booking
• Only 2 immediate denture bookings per day
• Email Dr. Knechtel to advise him of booking
• date of booking
• # of teeth to be extracted
• CD (single or set)
• RPD

• At least one week prior, students must review medical history & clinical surgical details with supervising surgeon
• At beginning of clinic inform both attending
Surgeon and Dr. Knechtel that your patient has an immediate denture
• This ensures the patient moves to top of rotation, so that insertion is as early in clinic as possible

• Students must see patient the day after delivery ,
Friday morning to ensure patient comfortable
• All immediate dentures insertions supervised by
Dr. Knechtel.

• Examination/Diagnosis/Treatment Plan
• Informed consent
• Alternatives
• Pros/cons
• Prognosis
• Timing
• Costs

Examination/Diagnosis/Treatment Plan
• Beware of tissue undercuts
• Especially anterior maxilla & tuberosities
• Make notes to reduce at time of extractions
• Compress socket
• Bony reduction if necessary
• If not reduced, denture may not seat
• 2 piece tray for impression

Examination/Diagnosis/Treatment Plan
• Determine if OVD requires change at diagnosis appointment
• Use physiologic rest, interocclusal space measurements

Examination/Diagnosis/Treatment Plan
• To improve esthetics & ensure adequate stability:
• Decide whether you will need to imitate or change tooth arrangement prior to beginning
• Helps avoid unexpected surprises

• Oral hygiene procedures
• Reduce inflammation to speed healing
• Reduced discomfort after extractions
• Less soft tissue changes – better fit

• Preliminary extractions - posterior teeth
• Keep one set of opposing teeth on each side of arch if
OVD and centric are to be preserved
• Wait 4 weeks for healing
• If very few teeth remain
• Consider extracting all at once
• Skip preliminary extraction step
• Less morbidity
Extract All Teeth Single Appointment

Technique After Preliminary Extractions
• Preliminary impressions - alginate
• Final impressions – 1 or 2 step
• Jaw relation records
• Tooth set-up and try-in
• Final extractions and insertion
• Post insertion care

Examination/Diagnosis/Treatment Plan
• Reconfirm decision to imitate or change tooth arrangement
• Determine midlines, occlusal plane, vertical overlap, length of maxillary incisors
• Mark on cast for laboratory to use for setup

• Stock trays
• Dentate or partially-edentulous
• Irreversible Hydrocolloid
• Mark vibrating line & hamular notches prior to impression
• Can’t reseat intraorally

• Use 2 piece custom tray if significant undercuts
• If no large tissue undercuts use one piece custom tray

Mark Posterior Border Prior to Impression
• Vibrating line & hamular notches
• Not able to reseat intraorally
• tooth & tissue undercuts, embrasures
• If don ’t have correct posterior border, denture will not be retentive

Custom Tray – Ensure
Alginate Not Too Thin
Stock Tray

• Block out minor undercuts
• Ensure tray flange not too far from vestibule
• After border molding, should not lock into place

• Record base & occlusion rim used if unstable cast/contacts
(wobbles, rocks)
• Make facebow record with dentate bitefork
• Use for centric & protrusion
• If stable contacts, record base not needed

Jaw Relation Records
• Determine OVD
• Use physiologic rest, interocclusal space measurements
• Do NOT incorporate an overbite in occlusion rims
• if anterior teeth are missing, use rims only to determine OVD, not incisal display
• Once mounted, determine overbite, incisal display required

Use occlusion rims for OVD, Jaw Relations Records

Dentate Bitefork wth Wax/PVS
Centric Record
Use PVS Bite Registration Material, NOT Wax

Anterior Try-in Only Possible if Anterior Teeth Missing

• Have lab complete set up & modify cast as directed
• use probing depths & radiographs to guide cast modification

Do not create large socket convexities – grind teeth

Final Setup Usually will not allow for Full Wax Try-in

• Always request a surgical stent (guide)
• Prescribe fabrication of stent when sent for processing
• Allows for identifying areas of impingement (blanching)

• Extract teeth
• Prior to insertion, use surgical guide to assess ridge
• Place pressure but DONOT Flex during insertion
• check for over extensions, pressure (blanching)
• Seat the denture
• After stent show full seating, no blanching

THE DENTURE MUST BE FULLY SEATED
• Otherwise occlusion will be unacceptable
• Once fully seated, adjust occlusion as needed
• Provide post insertion instructions
• Verbal
• Written – patient brochure

0 -15 min
- Inform surgeon & Dr. Knechtel patient is receiving an immediate denture
- review med history
- provide local anaesthesia
15 - 60 min
- extractions
1 - 2 hour
- insert and adjust
- instructions

• Do not remove until 24 hour appointment
• If it comes loose/out replace immediately
• Soft/liquid diet for 24 hours
• Avoid vigorous rinsing
• Take analgesic as prescribed
• Expect red saliva

• Remove and clean denture
• Relieve sore spots
• Do not use PIP – use indelible stick
• Gross occlusal adjustment

• Relieve sore spots
• Use PIP
• Refine occlusion – possible remount

• Tissue conditioner to improve retention as needed
• Remove any socket convexities to avoid healing defects
• Reline or remake in 4 to 6 months
• Postpone as long as patient can tolerate to ensure most of initial resorption complete

X
X
Remove denture base convexities to avoid healing defects
X